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Vitamin A
Fact Sheet for Health Professionals

Introduction
Table of Contents

Introduction Vitamin A is the name of a group of fat-soluble

Recommended Intakes retinoids, including retinol, retinal, and retinyl esters [1-
Sources of Vitamin A 3]. Vitamin A is involved in immune function, vision,
Vitamin A Intakes and Status reproduction, and cellular communication [1,4,5].
Vitamin A Deficiency Vitamin A is critical for vision as an essential
Groups at Risk of Vitamin A component of rhodopsin, a protein that absorbs light in  
Inadequacy the retinal receptors, and because it supports the
Vitamin A and Health normal differentiation and functioning of the Top
Health Risks from Excessive conjunctival membranes and cornea [2-4]. Vitamin A
Vitamin A also supports cell growth and differentiation, playing a
Interactions with Medications critical role in the normal formation and maintenance of Have a question?
Vitamin A and Healthful Diets the heart, lungs, kidneys, and other organs [2]. Ask ODS: ods.od.nih.gov/contact
References
Disclaimer Two forms of vitamin A are available in the human diet:
preformed vitamin A (retinol and its esterified form, retinyl ester) and provitamin A carotenoids [1-5].
Preformed vitamin A is found in foods from animal sources, including dairy products, fish, and meat
(especially liver). By far the most important provitamin A carotenoid is beta-carotene; other provitamin A carotenoids are alpha-carotene and beta-
cryptoxanthin. The body converts these plant pigments into vitamin A. Both provitamin A and preformed vitamin A must be metabolized intracellularly
to retinal and retinoic acid, the active forms of vitamin A, to support the vitamin’s important biological functions [2,3]. Other carotenoids found in food,
such as lycopene, lutein, and zeaxanthin, are not converted into vitamin A.

The various forms of vitamin A are solubilized into micelles in the intestinal lumen and absorbed by duodenal mucosal cells [5]. Both retinyl esters and
provitamin A carotenoids are converted to retinol, which is oxidized to retinal and then to retinoic acid [2]. Most of the body’s vitamin A is stored in the
liver in the form of retinyl esters.

Retinol and carotenoid levels are typically measured in plasma, and plasma retinol levels are useful for assessing vitamin A inadequacy. However,
their value for assessing marginal vitamin A status is limited because they do not decline until vitamin A levels in the liver are almost depleted [3]. Liver
vitamin A reserves can be measured indirectly through the relative dose-response test, in which plasma retinol levels are measured before and after
the administration of a small amount of vitamin A [5]. A plasma retinol level increase of at least 20% indicates an inadequate vitamin A level [3,5,6].
For clinical practice purposes, plasma retinol levels alone are sufficient for documenting significant deficiency.

A plasma retinol concentration lower than 0.70 micromoles/L (or 20 micrograms [mcg]/dL) reflects vitamin A inadequacy in a population, and
concentrations of 0.70–1.05 micromoles/L could be marginal in some people [5]. In some studies, high plasma or serum concentrations of some
provitamin A carotenoids have been associated with a lower risk of various health outcomes, but these studies have not definitively demonstrated that
this relationship is causal.

Recommended Intakes

Intake recommendations for vitamin A and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition
Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences) [5]. DRI is the general term for a set of
reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and gender, include:

Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%)
healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an
RDA.
Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually
used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient
intakes of individuals.
Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects.

RDAs for vitamin A are given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A
carotenoids (see Table 1). Because the body converts all dietary sources of vitamin A into retinol, 1 mcg of physiologically available retinol is
equivalent to the following amounts from dietary sources: 1 mcg of retinol, 12 mcg of beta-carotene, and 24 mcg of alpha-carotene or beta-
cryptoxanthin. From dietary supplements, the body converts 2 mcg of beta-carotene to 1 mcg of retinol.

Currently, vitamin A is listed on food and supplement labels in international units (IUs) even though nutrition scientists rarely use this measure.
Conversion rates between mcg RAE and IU are as follows [7]:

1 IU retinol = 0.3 mcg RAE

1 IU beta-carotene from dietary supplements = 0.15 mcg RAE
1 IU beta-carotene from food = 0.05 mcg RAE
1 IU alpha-carotene or beta-cryptoxanthin = 0.025 mcg RAE

However, under FDA’s new labeling regulations for foods and dietary supplements that take effect by January 1, 2020 (for companies with annual
sales of $10 million or more) or January 1, 2021 (for smaller companies), vitamin A will be listed only in mcg RAE and not IUs [8,9].

An RAE cannot be directly converted into an IU without knowing the source(s) of vitamin A. For example, the RDA of 900 mcg RAE for adolescent and
adult men is equivalent to 3,000 IU if the food or supplement source is preformed vitamin A (retinol). However, this RDA is also equivalent to 6,000 IU
of beta-carotene from supplements, 18,000 IU of beta-carotene from food, or 36,000 IU of alpha-carotene or beta-cryptoxanthin from food. So a mixed
diet containing 900 mcg RAE provides between 3,000 and 36,000 IU of vitamin A, depending on the foods consumed.

Table 1: Recommended Dietary Allowances (RDAs) for Vitamin A [5]

Age Male Female Pregnancy Lactation
0–6 months* 400 mcg RAE 400 mcg RAE    
7–12 months* 500 mcg RAE 500 mcg RAE    
1–3 years 300 mcg RAE 300 mcg RAE    
4–8 years 400 mcg RAE 400 mcg RAE    
9–13 years 600 mcg RAE 600 mcg RAE    
14–18 years 900 mcg RAE 700 mcg RAE 750 mcg RAE 1,200 mcg RAE
19–50 years 900 mcg RAE 700 mcg RAE 770 mcg RAE 1,300 mcg RAE
51+ years 900 mcg RAE 700 mcg RAE    

* Adequate Intake (AI), equivalent to the mean intake of vitamin A in healthy, breastfed infants.

Sources of Vitamin A

Food
Concentrations of preformed vitamin A are highest in liver and fish oils [2]. Other sources of preformed vitamin A are milk and eggs, which also include
some provitamin A [2]. Most dietary provitamin A comes from leafy green vegetables, orange and yellow vegetables, tomato products, fruits, and some
vegetable oils [2]. The top food sources of vitamin A in the U.S. diet include dairy products, liver, fish, and fortified cereals; the top sources of
provitamin A include carrots, broccoli, cantaloupe, and squash [4,5].

Table 2 suggests many dietary sources of vitamin A. The foods from animal sources in Table 2 contain primarily preformed vitamin A, the plant-based
foods have provitamin A, and the foods with a mixture of ingredients from animals and plants contain both preformed vitamin A and provitamin A.

Table 2: Selected Food Sources of Vitamin A [11]

mcg RAE
per IU per Percent
Food serving serving DV*
Sweet potato, baked in skin, 1 whole 1,403 28,058 561
Beef liver, pan fried, 3 ounces 6,582 22,175 444
Spinach, frozen, boiled, ½ cup 573 11,458 229
Carrots, raw, ½ cup 459 9,189 184
Pumpkin pie, commercially prepared, 1 piece 488 3,743 249
Cantaloupe, raw, ½ cup 135 2,706 54
Peppers, sweet, red, raw, ½ cup 117 2,332 47
Mangos, raw, 1 whole 112 2,240 45
Black-eyed peas (cowpeas), boiled, 1 cup 66 1,305 26
Apricots, dried, sulfured, 10 halves 63 1,261 25
Broccoli, boiled, ½ cup 60 1,208 24
Ice cream, French vanilla, soft serve, 1 cup 278 1,014 20
Cheese, ricotta, part skim, 1 cup 263 945 19
Tomato juice, canned, ¾ cup 42 821 16
Herring, Atlantic, pickled, 3 ounces 219 731 15
Ready-to-eat cereal, fortified with 10% of the DV for vitamin A, ¾–1 cup (more heavily fortified cereals might provide more of 127–149 500 10
the DV)
Milk, fat-free or skim, with added vitamin A and vitamin D, 1 cup 149 500 10
Baked beans, canned, plain or vegetarian, 1 cup 13 274 5
Egg, hard boiled, 1 large 75 260 5
Summer squash, all varieties, boiled, ½ cup 10 191 4
Salmon, sockeye, cooked, 3 ounces 59 176 4
Yogurt, plain, low fat, 1 cup 32 116 2
Pistachio nuts, dry roasted, 1 ounce 4 73 1
Tuna, light, canned in oil, drained solids, 3 ounces 20 65 1
Chicken, breast meat and skin, roasted, ½ breast 5 18 0

*DV = Daily Value. FDA developed DVs to help consumers compare the nutrient contents of products within the context of a total diet. The DV for
vitamin A used for the values in Table 2 is 5,000 IU for adults and children age 4 years and older [10]. This DV, however, is changing to 900 mcg RAE
as the updated Nutrition and Supplement Facts labels are implemented [8]; (1 mcg RAE = 1 mcg retinol, 2 mcg beta-carotene from supplements, 12
mcg beta-carotene from foods, 24 mcg alpha-carotene, or 24 mcg beta-cryptoxanthin). The updated labels and DVs must appear on food products and
dietary supplements beginning in January 2020, but they can be used now [9]. FDA requires current food labels to list vitamin A content, but this
requirement will be dropped with the updated labels. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods
providing lower percentages of the DV also contribute to a healthful diet.

The U.S. Department of Agriculture’s (USDA’s) National Nutrient Database [11] lists the nutrient content of many foods and provides a
comprehensive list of foods containing vitamin A in IUs arranged by nutrient content and by food name, and foods containing beta-carotene in mcg
arranged by nutrient content and by food name.

Dietary supplements
Vitamin A is available in multivitamins and as a stand-alone supplement, often in the form of retinyl acetate or retinyl palmitate [2]. A portion of the
vitamin A in some supplements is in the form of beta-carotene and the remainder is preformed vitamin A; others contain only preformed vitamin A or
only beta-carotene. Supplement labels usually indicate the percentage of each form of the vitamin. The amounts of vitamin A in stand-alone
supplements range widely [2]. Multivitamin supplements typically contain 2,500–10,000 IU vitamin A, often in the form of both retinol and beta-
carotene.

About 28%–37% of the general population uses supplements containing vitamin A [12]. Adults aged 71 years or older and children younger than 9 are
more likely than members of other age groups to take supplements containing vitamin A.

Vitamin A Intakes and Status

According to an analysis of data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES), the average daily dietary vitamin
A intake in Americans aged 2 years and older is 607 mcg RAE [13]. Adult men have slightly higher intakes (649 mcg RAE) than adult women (580
mcg RAE). Although these intakes are lower than the RDAs for individual men and women, these intake levels are considered to be adequate for
population groups.

Data from NHANES III, conducted in 1988–1994, found that approximately 26% of the vitamin A in RAEs consumed by men and 34% of that
consumed by women in the United States comes from provitamin A carotenoids, with the remainder coming from preformed vitamin A, mostly in the
form of retinyl esters [5].

The adequacy of vitamin A intake decreases with age in children [4]. Furthermore, girls and African-American children have a higher risk of consuming
less than two-thirds of the vitamin A RDA than other children [4].

Vitamin A Deficiency

Frank vitamin A deficiency is rare in the United States. However, vitamin A deficiency is common in many developing countries, often because
residents have limited access to foods containing preformed vitamin A from animal-based food sources and they do not commonly consume available
foods containing beta-carotene due to poverty [2]. According to the World Health Organization, 190 million preschool-aged children and 19.1 million
pregnant women around the world have a serum retinol concentration below 0.70 micromoles/L [14]. In these countries, low vitamin A intake is most
strongly associated with health consequences during periods of high nutritional demand, such as during infancy, childhood, pregnancy, and lactation.

In developing countries, vitamin A deficiency typically begins during infancy, when infants do not receive adequate supplies of colostrum or breast milk
[14]. Chronic diarrhea also leads to excessive loss of vitamin A in young children, and vitamin A deficiency increases the risk of diarrhea [5,15]. The
most common symptom of vitamin A deficiency in young children and pregnant women is xerophthalmia. One of the early signs of xerophthalmia is
night blindness, or the inability to see in low light or darkness [2,16]. Vitamin A deficiency is one of the top causes of preventable blindness in children
[14]. People with vitamin A deficiency (and, often, xerophthalmia with its characteristic Bitot’s spots) tend to have low iron status, which can lead to
anemia [3,14]. Vitamin A deficiency also increases the severity and mortality risk of infections (particularly diarrhea and measles) even before the
onset of xerophthalmia [5,14,16].

Groups at Risk of Vitamin A Inadequacy

The following groups are among those most likely to have inadequate intakes of vitamin A.

Premature Infants
In developed countries, clinical vitamin A deficiency is rare in infants and occurs only in those with malabsorption disorders [17]. However, preterm
infants do not have adequate liver stores of vitamin A at birth and their plasma concentrations of retinol often remain low throughout the first year of life
[17,18]. Preterm infants with vitamin A deficiency have an increased risk of eye, chronic lung, and gastrointestinal diseases [17].

Infants and Young Children in Developing Countries

In developed countries, the amounts of vitamin A in breast milk are sufficient to meet infants’ needs for the first 6 months of life. But in women with
vitamin A deficiency, breast milk volume and vitamin A content are suboptimal and not sufficient to maintain adequate vitamin A stores in infants who
are exclusively breastfed [19]. The prevalence of vitamin A deficiency in developing countries begins to increase in young children just after they stop
breastfeeding [3]. The most common and readily recognized symptom of vitamin A deficiency in infants and children is xerophthalmia.

Pregnant and Lactating Women in Developing Countries

Pregnant women need extra vitamin A for fetal growth and tissue maintenance and for supporting their own metabolism [20]. The World Health
Organization estimates that 9.8 million pregnant women around the world have xerophthalmia as a result of vitamin A deficiency [14]. Other effects of
vitamin A deficiency in pregnant and lactating women include increased maternal and infant morbidity and mortality, increased anemia risk, and slower
infant growth and development.

People with Cystic Fibrosis

Most people with cystic fibrosis have pancreatic insufficiency, increasing their risk of vitamin A deficiency due to difficulty absorbing fat [21,22]. Several
cross-sectional studies found that 15%–40% of patients with cystic fibrosis have vitamin A deficiency [23]. However, improved pancreatic replacement
treatments, better nutrition, and caloric supplements have helped most patients with cystic fibrosis become vitamin A sufficient [22]. Several studies
have shown that oral supplementation can correct low serum beta-carotene levels in people with cystic fibrosis, but no controlled studies have
examined the effects of vitamin A supplementation on clinical outcomes in patients with cystic fibrosis [22-24].

Vitamin A and Health

This section focuses on three diseases and disorders in which vitamin A might play a role: cancer, age-related macular degeneration (AMD), and
measles.

Cancer
Because of the role vitamin A plays in regulating cell growth and differentiation, several studies have examined the association between vitamin A and
various types of cancer. However, the relationship between serum vitamin A levels or vitamin A supplementation and cancer risk is unclear.

Several prospective and retrospective observational studies in current and former smokers, as well as in people who have never smoked, found that
higher intakes of carotenoids, fruits and vegetables, or both are associated with a lower risk of lung cancer [1,25]. However, clinical trials have not
shown that supplemental beta-carotene and/or vitamin A helps prevent lung cancer. In the Carotene and Retinol Efficacy Trial (CARET), 18,314
current and former smokers (including some males who had been occupationally exposed to asbestos) took daily supplements containing 30 mg beta-
carotene and 25,000 IU retinyl palmitate for 4 years, on average [26]. In the Alpha-Tocopherol, Beta-Carotene (ATBC) Cancer Prevention Study,
29,133 male smokers took 50 mg/day alpha-tocopherol, 20 mg/day beta-carotene, 50 mg/day alpha-tocopherol and 20 mg/day beta-carotene, or
placebo for 5–8 years [27]. In the beta-carotene component of the Physicians’ Health Study, 22,071 male physicians took 325 mg aspirin plus 50 mg
beta-carotene, 50 mg beta-carotene plus aspirin placebo, 325 mg aspirin plus beta-carotene placebo, or both placebos every other day for 12 years
[28]. In all three of these studies, taking very high doses of beta-carotene, with or without 25,000 IU retinyl palmitate or 325 mg aspirin, did not prevent
lung cancer. In fact, both the CARET and ATBC studies showed a significant increase in lung cancer risk among study participants taking beta-
carotene supplements or beta-carotene and retinyl palmitate supplements. The Physicians’ Health Study did not find an increased lung cancer risk in
participants taking beta-carotene supplements, possibly because only 11% of physicians in the study were current or former smokers.

The evidence on the relationship between beta-carotene and prostate cancer is mixed. CARET study participants who took daily supplements of beta-
carotene and retinyl palmitate had a 35% lower risk of nonaggressive prostate cancer than men not taking the supplements [29]. However, the ATBC
study found that baseline serum beta-carotene and retinol levels and supplemental beta-carotene had no effect on survival [30]. Moreover, men in the
highest quintile of baseline serum retinol levels were 20% more likely to develop prostate cancer than men in the lowest quintile [31].

The ATBC and CARET study results suggest that large supplemental doses of beta-carotene with or without retinyl palmitate have detrimental effects
in current or former smokers and workers exposed to asbestos. The relevance of these results to people who have never smoked or to the effects of
beta-carotene or retinol from food or multivitamins (which typically have modest amounts of beta-carotene) is not known. More research is needed to
determine the effects of vitamin A on prostate, lung, and other types of cancer.

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a major cause of significant vision loss in older people. AMD’s etiology is usually unknown, but the
cumulative effect of oxidative stress is postulated to play a role. If so, supplements containing carotenoids with antioxidant functions, such as beta-
carotene, lutein, and zeaxanthin, might be useful for preventing or treating this condition. Lutein and zeaxanthin, in particular, accumulate in the retina,
the tissue in the eye that is damaged by AMD.

The Age-Related Eye Disease Study (AREDS), a large randomized clinical trial, found that participants at high risk of developing advanced AMD (i.e.,
those with intermediate AMD or those with advanced AMD in one eye) reduced their risk of developing advanced AMD by 25% by taking a daily
supplement containing beta-carotene (15 mg), vitamin E (400 IU dl-alpha-tocopheryl acetate), vitamin C (500 mg), zinc (80 mg), and copper (2 mg) for
5 years compared to participants taking a placebo [32].

A follow-up AREDS2 study confirmed the value of this supplement in reducing the progression of AMD over a median follow-up period of 5 years but
found that adding lutein (10 mg) and zeaxanthin (2 mg) or omega-3 fatty acids to the formulation did not confer any additional benefits [33].
Importantly, the study revealed that beta-carotene was not a required ingredient; the original AREDS formulation without beta-carotene provided the
same protective effect against developing advanced AMD. In a more detailed analysis of results, supplementation with lutein and zeaxanthin reduced
the risk of advanced AMD by 26% in participants with the lowest dietary intakes of these two carotenoids who took a supplement containing them
compared to those who did not take a supplement with these carotenoids [33]. The risk of advanced AMD was also 18% lower in participants who took
the modified AREDS supplement containing lutein and zeaxanthin but not beta-carotene than in participants who took the formulation with beta-
carotene but not lutein or zeaxanthin.

Individuals who have or are developing AMD should talk to their healthcare provider about taking one of the supplement formulations used in AREDS.

Measles
Measles is a major cause of morbidity and mortality in children in developing countries. About half of all measles deaths happen in Africa, but the
disease is not limited to low-income countries. Vitamin A deficiency is a known risk factor for severe measles. The World Health Organization
recommends high oral doses (200,000 IU) of vitamin A for two days for children over age 1 with measles who live in areas with a high prevalence of
vitamin A deficiency [34].

A Cochrane review of eight randomized controlled trials of treatment with vitamin A for children with measles found that 200,000 IU of vitamin A on
each of two consecutive days reduced mortality from measles in children younger than 2 and mortality due to pneumonia in children [34]. Vitamin A
also reduced the incidence of croup but not pneumonia or diarrhea, although the mean duration of fever, pneumonia, and diarrhea was shorter in
children who received vitamin A supplements. A meta-analysis of six high-quality randomized controlled trials of measles treatment also found that two
doses of 100,000 IU in infants and 200,000 IU in older children significantly reduced measles mortality [35]. The vitamin A doses used in these studies
are much higher than the UL. The effectiveness of vitamin A supplementation to treat measles in countries, such as the United States, where vitamin
A intakes are usually adequate is uncertain.

The body needs vitamin A to maintain the corneas and other epithelial surfaces, so the lower serum concentrations of vitamin A associated with
measles, especially in people with protein-calorie malnutrition, can lead to blindness. None of the studies evaluated in a Cochrane review evaluated
blindness as a primary outcome [36]. However, a careful clinical investigation of 130 African children with measles revealed that half of all corneal
ulcers in these children, and nearly all bilateral blindness, occurred in those with vitamin A deficiency [37].

Health Risks from Excessive Vitamin A

Because vitamin A is fat soluble, the body stores excess amounts, primarily in the liver, and these levels can accumulate. Although excess preformed
vitamin A can have significant toxicity (known as hypervitaminosis A), large amounts of beta-carotene and other provitamin A carotenoids are not
associated with major adverse effects [38]. The manifestations of hypervitaminosis A depend on the size and rapidity of the excess intake. The
symptoms of hypervitaminosis A following sudden, massive intakes of vitamin A, as with Arctic explorers who ate polar bear liver, are acute [39].
Chronic intakes of excess vitamin A lead to increased intracranial pressure (pseudotumor cerebri), dizziness, nausea, headaches, skin irritation, pain
in joints and bones, coma, and even death [2,4,5]. Although hypervitaminosis A can be due to excessive dietary intakes, the condition is usually a
result of consuming too much preformed vitamin A from supplements or therapeutic retinoids [3,5]. When people consume too much vitamin A, their
tissue levels take a long time to fall after they discontinue their intake, and the resulting liver damage is not always reversible.

Observational studies have suggested an association between high intakes of preformed vitamin A (more than 1,500 mcg daily—only slightly higher
than the RDA), reduced bone mineral density, and increased fracture risk [1,4,40]. However, the results of studies on this risk have been mixed, so the
safe retinol intake level for this association is unknown.

Total intakes of preformed vitamin A that exceed the UL and some synthetic retinoids used as topical therapies (such as isotretinoin and etretinate) can
cause congenital birth defects [2-4]. These birth defects can include malformations of the eye, skull, lungs, and heart [4]. Women who might be
pregnant should not take high doses of vitamin A supplements [2].

Unlike preformed vitamin A, beta-carotene is not known to be teratogenic or lead to reproductive toxicity [1]. And even large supplemental doses (20–
30 mg/day) of beta-carotene or diets with high levels of carotenoid-rich food for long periods are not associated with toxicity. The most significant effect
of long-term, excess beta-carotene is carotenodermia, a harmless condition in which the skin becomes yellow-orange [1,25]. This condition can be
reversed by discontinuing beta-carotene ingestion.

Supplementation with beta-carotene, with or without retinyl palmitate, for 5–8 years has been associated with an increased risk of lung cancer and
cardiovascular disease in current and former male and female smokers and in male current and former smokers occupationally exposed to asbestos
[27,41]. In the ATBC study, beta-carotene supplements (20 mg daily) were also associated with increased mortality, mainly due to lung cancer and
ischemic heart disease [27]. The CARET study ended early, after the investigators found that daily beta-carotene (30 mg) and retinyl palmitate (25,000
IU) supplements increased the risk of lung cancer and cardiovascular disease mortality [41].

The FNB has established ULs for preformed vitamin A that apply to both food and supplement intakes [5]. The FNB based these ULs on the amounts
associated with an increased risk of liver abnormalities in men and women, teratogenic effects, and a range of toxic effects in infants and children. The
FNB also considered levels of preformed vitamin A associated with decreased bone mineral density, but did not use these data as the basis for its ULs
because the evidence was conflicting. The FNB has not established ULs for beta-carotene and other provitamin A carotenoids [25]. The FNB advises
against beta-carotene supplements for the general population, except as a provitamin A source to prevent vitamin A deficiency.

Table 3: Tolerable Upper Intake Levels (ULs) for Preformed Vitamin A [5]*
Age Male Female Pregnancy Lactation
0–12 months 600 mcg RAE 600 mcg RAE    
(2,000 IU) (2,000 IU)
1–3 years 600 mcg RAE 600 mcg RAE    
(2,000 IU) (2,000 IU)
4–8 years 900 mcg RAE 900 mcg RAE    
(3,000 IU) (3,000 IU)
9–13 years 1,700 mcg RAE 1,700 mcg RAE    
(5,667 IU) (5,667 IU)
14–18 years 2,800 mcg RAE 2,800 mcg RAE 2,800 mcg RAE 2,800 mcg RAE
(9,333 IU) (9,333 IU) (9,333 IU) (9,333 IU)
19+ years 3,000 mcg RAE 3,000 mcg RAE 3,000 mcg RAE 3,000 mcg RAE
(10,000 IU) (10,000 IU) (10,000 IU) (10,000 IU)

* These ULs, expressed in mcg and in IUs (where 1 mcg = 3.33 IU), only apply to products from animal sources and supplements whose vitamin A
comes entirely from retinol or ester forms, such as retinyl palmitate. However, many dietary supplements (such as multivitamins) do not provide all of
their vitamin A as retinol or its ester forms. For example, the vitamin A in some supplements consists partly or entirely of beta-carotene or other
provitamin A carotenoids. In such cases, the percentage of retinol or retinyl ester in the supplement should be used to determine whether an
individual’s vitamin A intake exceeds the UL. For example, a supplement labeled as containing 10,000 IU of vitamin A with 60% from beta-carotene
(and therefore 40% from retinol or retinyl ester) provides 4,000 IU of preformed vitamin A. That amount is above the UL for children from birth to 13
years but below the UL for adolescents and adults.

Interactions with Medications

Vitamin A can interact with certain medications, and some medications can have an adverse effect on vitamin A levels. A few examples are provided
below. Individuals taking these and other medications on a regular basis should discuss their vitamin A status with their healthcare providers.

Orlistat
Orlistat (Alli®, Xenical®), a weight-loss treatment, can decrease the absorption of vitamin A, other fat-soluble vitamins, and beta-carotene, causing low
plasma levels in some patients [42]. The manufacturers of Alli and Xenical recommend encouraging patients on orlistat to take a multivitamin
supplement containing vitamin A and beta-carotene, as well as other fat-soluble vitamins [43,44].

Retinoids

Several synthetic retinoids derived from vitamin A are used orally as prescription medicines. Examples include the psoriasis treatment acitretin
(Soriatane®) and bexarotene (Targretin®), used to treat the skin effects of T-cell lymphoma. Retinoids can increase the risk of hypervitaminosis A
when taken in combination with vitamin A supplements [42].

Vitamin A and Healthful Diets

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods. … Foods in
nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive
health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be
consumed in less-than-recommended amounts.”

For more information about building a healthy diet, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture’s MyPlate
.

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.

Many fruits, vegetables, and dairy products are good sources of vitamin A. Some ready-to-eat breakfast cereals are fortified with vitamin
A.

Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.

Beef liver contains high amounts of vitamin A. Other sources of the nutrient include some fish, beans, and nuts.

Limits saturated and trans fats, added sugars, and sodium.

Stays within your daily calorie needs.

References

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London and New York: Informa Healthcare; 2010:115-20.
2. Ross CA. Vitamin A. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. London and New York:
Informa Healthcare; 2010:778-91.
3. Ross A. Vitamin A and Carotenoids. In: Shils M, Shike M, Ross A, Caballero B, Cousins R, eds. Modern Nutrition in Health and Disease. 10th
ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006:351-75.
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Disclaimer

This fact sheet by the Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you
to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements
and what may be best for your overall health. Any mention in this publication of a specific product or service, or recommendation from an organization
or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.

Updated: October 5, 2018 History of changes to this fact sheet

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